Can tech change the future of therapy?

I’m standing on the 100th floor of a building in the central business district. Up here, I can hear the wind whistling, with the muted sounds of traffic below. My high vantage point means that I can see the rooftops of neighbouring skyscrapers.

If I tip my legs over the edge, the fall will most likely be fatal. If I had a fear of heights, this location would trigger my anxiety.

But despite the sensations, I’m actually safe. Physically, I’m not on a precarious ledge. I’m sitting in an office chair at Olive Branch Psychology & Therapy Clinic in Singapore, immersed in a therapy session wearing a virtual reality (VR) headset. The session is facilitated by centre director and psychologist Sam Roberts.

While using VR for entertainment isn’t out of the ordinary, its application is increasingly extending beyond leisure – it’s now becoming a popular modality for mental health care. When utilised effectively, these computer- simulated worlds offer a profound form of treatment for many mental health conditions.

A number of studies have shown that VR therapy is linked to reduced symptom severity in both post-traumatic stress disorder (PTSD) and depression, and it has demonstrated significant promise in providing pain relief as an alternative to traditional medications.

For instance, a study published in the Annals of Behavioral Medicine, one of the journals of the Society of Behavioral Medicine, showcased how burn victims experienced substantial reductions in physical pain – ranging from 35 to 50 per cent – by engaging in immersive virtual environments, such as interacting with snowmen and throwing snowballs in a snowy world.

How VR therapy works

“VR therapy is a form of exposure therapy,” explains Sam, who has been employing VR therapy as an adjunct treatment for phobias for three years. Each session typically lasts 20 to 30 minutes, depending on the individual’s level of fear.

How does the VR equipment come into place during a therapy session? Sam emphasises that it isn’t immediately introduced in the first session, particularly if the client isn’t ready. Instead, each session begins like a traditional therapy session, where the soft-spoken counsellor engages in dialogue with the client.

“First, we need to understand the psychodynamics – meaning, what’s happening and where their fear came from,” he explains. VR is then brought into the therapy process if deemed necessary, serving as an additional tool to help confront specific scenarios.

Sam tailors the VR environment to address the client’s specific needs and the severity of their phobia. For example, he might create a virtual presentation room or stage to help those with stage fright overcome their fear of public speaking. “We can also transport socially anxious individuals to a virtual restaurant or bar, where they can interact with simulated characters,” he adds.

Like many others, I have a moderate fear of cockroaches, though I wouldn’t say my fear is rooted in trauma. The psychologist decides to simulate an environment with cockroaches. He gradually increases the exposure level, starting with placing me in a room where a glass case of cockroaches sits at the end of a table. With him controlling the VR program via a laptop, the virtual cockroaches begin to stir and climb out of the case, heading towards me.

Though it gives me the heebie-jeebies, the knowledge that it’s all virtual (and constantly rubbing my hands to make sure no real cockroaches are crawling all over them) provides reassurance.

Just how effective can VR therapy be when you are aware that you’re physically not within the environment? “Through repeated exposure and guided therapeutic interventions, the skills learnt in the virtual environment can generalise to real-life situations, where individuals report feeling more confident and better equipped to face their fear outside of the therapy setting,” explains Sam.

While a single 30-minute session did not eradicate my fear entirely, it does provide reassurance that cockroaches pose no harmful intentions towards me. (Though I’m 100 per cent sure I’ll still scream if I see a cockroach flying towards me.)

Other forms of tech in therapy

In addition to VR, wearable devices also offer a unique opportunity to gain insights into individuals’ mental states. According to global market research company Facts and Factors, the global wearable device market size is expected to cross US$380 billion ($512 billion) by 2028. The number of health and fitness app users has crossed 91 million in 2023.

Wearable devices offer continuous monitoring of physiological data, such as heart rate, sleep patterns, and activity levels, providing valuable insights into an individual’s mental and physical well-being.

For example, smartwatches such as the Apple Watch can track changes in heart rate variability, which may indicate stress levels or mood fluctuations, while Oura Rings monitor sleep quality and recovery metrics. Then, there’s also a growing prevalence of AI chatbots and teletherapy services, offering easy accessibility for individuals who need instant support. US-based platforms such as Betterhelp, Talkspace, and Amwell provide remote therapy sessions with licensed mental health professionals through video conferencing, chat, or phone calls.

In Singapore, local mental health practices are also embracing telehealth services. Dr. Annabelle Chow, founder and principal clinical psychologist at Annabelle Psychology, says: “Telehealth is integrated with in-clinic therapy, offering a hybrid approach tailored to each client’s needs.”

For instance, clients might initially attend sessions in person to establish rapport with their therapist, then transition to telehealth for ongoing support. This approach ensures regularity and consistency, while also giving individuals access to clinicians with specific niches or specialisations that may not be readily available locally. She sees potential for AI to assist in triaging clients, prioritising those in urgent need of help, and preparing standard lists of resources based on the AI’s assessment of clinical presentations.

There is also a plethora of mental health apps available for smartphones, offering features such as mood tracking, guided meditation, cognitive-behavioural therapy, stress reduction techniques, and self-help resources. AI-powered chatbots provide instant support and guidance, serving as conversational interfaces for accessing coping strategies, information, and emotional support.

Hannah Ong, a 27-year-old accountant diagnosed with depression two years ago, uses Wysa, a mental health support app. “I discovered the app by searching ‘mental health’ in the app store,” she says. Out of all the other mental health apps, she decided to download Wysa in particular as she was attracted to its easy-to-use interface, and positive reviews from other users.

As her condition has improved since her diagnosis, she has gradually reduced her therapy sessions with her counsellor. Wysa assists her on days when she’s feeling down, allowing her to vent and engage in reflective exercises. “Talking to the AI chatbot helps me reflect, and be more aware of my emotions and feelings,” she shares, adding that due to the fact that “it’s a non-living being, I feel that there is less judgement”.

Tech's important role in mental healthcare

The integration of tech into mental health treatment represents a significant shift in how therapy is accessed and delivered. In 2020, when the Covid-19 pandemic forced so many of us to work from home and transition to virtual platforms like Zoom, mental health professionals – psychiatrists, psychotherapists and social workers – followed suit.

But what initially emerged as a response to the Covid-19 pandemic has now become a permanent fixture.

Recent data from the American Psychological Association reveals a widespread adoption of remote therapy services, with 96 per cent of clinical psychologists offering some form of remote treatment. This shift has dramatically improved access to treatment for conditions such as anxiety, depression, and PTSD.

The World Health Organization’s World Mental Health Report, published in 2022, underscores the rapid integration of digital technologies into the mental health care landscape. Online consultations alleviate the need for travel, reducing time and cost. They also offer greater flexibility, easily fitting into people’s work or home schedules.

These innovations are backed by significant financial support, with global investment in mental health technology surpassing US$5 billion ($6.7 billion) in 2021 alone, marking a remarkable 139 per cent increase from the previous year.

A report published in January 2024 by the global market research and consulting firm, The Business Research Company, predicts this trend’s continuation, projecting the market to reach US$12.05 billion ($16.1 billion) in 2024, and US$31.03 billion ($41.6 billion) by 2028. Leading this market growth is the Asia-Pacific region, followed closely by Western Europe, North America, and other regions.

Sam anticipates a bright future for VR therapy, foreseeing its widespread adoption. “I envision increased accessibility and affordability of VR equipment, fostering inclusivity in therapy. Exciting prospects emerge with innovative modalities like integrating VR with mindfulness or art therapy for comprehensive treatment approaches,” he says.

While these advancements undeniably enhance accessibility, the question remains: can technology alone suffice as a comprehensive solution for mental health treatment?

Potential drawbacks

Well, it depends. The effectiveness of VR therapy in addressing various mental health issues is a topic of growing interest and research. A 2023 study conducted by psychologists in Amsterdam, Netherlands, and published in the Journal of Medical Internet Research, highlighted the success of VR therapy, particularly when used in conjunction with cognitive-behavioural therapy, reporting success rates ranging from 66 to 90 per cent for individuals with PTSD.

However, despite these promising results, questions regarding the long-term effectiveness of VR therapy persist. For example, in using VR for exposure therapy, can the fear or anxiety return after therapy?

“Certainly, relapse remains a possibility post-VR therapy, similar to other therapeutic methods,” says Sam. “Fear or anxiety may resurface due to various factors, including incomplete or premature treatment termination, difficulty in generalising coping skills, new life stressors triggering past anxieties, and inconsistent maintenance of learnt strategies.”

Therefore, while virtual reality therapy offers innovative solutions, the “human touch” remains indispensable in mental health treatment. “Regular follow-up sessions with a therapist are essential to reinforce coping techniques and address emerging concerns effectively,” says Sam.

Wearable technology on the other hand, also has its own limitations. The data collected by these devices may not always be accurate or reliable, due to user error – for example, if I don’t wear my smartwatch to bed, it’s unable to capture sleep data from me, which can affect the insights drawn from it.

Plus, wearing a device continuously can be uncomfortable or inconvenient for some, which might then lead to inconsistent usage.

And capturing the data is one thing, but interpreting the data? Complex insights might require specialised knowledge from healthcare professionals.

Similarly, when it comes to telehealth, one notable concern is the vulnerability of clients when seeking therapy online. Due diligence is crucial to finding a qualified therapist who can provide appropriate support and guidance tailored to individual needs.

When it comes to AI chatbots, Dr. Annabelle highlights the potential limitations of the technology right now, cautioning that clients may not always articulate their issues accurately, and the AI’s responses may not always address the underlying concerns adequately.

Despite advancements, the personalised support and connection offered in face-to-face interactions are still valued by many individuals seeking mental health support.

For Hannah, while the Wysa mental health app offers professional telehealth services with just one click, she still prefers in-person sessions with her therapist when necessary. She finds face-to-face interactions to be more comforting and effective in addressing her mental health needs.

The need for a human touch

Ultimately, while technology continues to revolutionise the field of mental health care, it's essential to remember that the human connection between therapist and client remains irreplaceable.

Despite promising advancements in technology-assisted therapy, it is the expertise, empathy, and personalised care provided by psychologists that truly drive meaningful therapeutic outcomes, says Dr. Annabelle.

“While AI and other technologies serve as valuable tools to increase access and promote desirable outcomes, it’s essential to recognise that psychologists remain the cornerstone of effective therapy,” she concludes.